STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BOF 117 (Rev. 11/2016) PAGE 1 of 2 CALIFORNIA DEPARTMENT OF JUSTICE BUREAU OF FIREARMS Certificate of Eligibility Report of Employment This form is to be completed and submitted to the Department of Justice (DOJ) when a person who currently holds a valid Certificate of Eligibility (COE) becomes an employee of a licensed California firearms dealer or California ammunition vendor who requires that his/her employee's obtain a COE (Pen. Code, §§ 26915 and 30347). The transmittal of this form to DOJ will associate the employee's name with the firearms dealer or ammunition vendor with whom they are employed. If during the term of this COE, or upon renewal, the employee is found to be lawfully prohibited from possessing firearms, the COE will be revoked and the licensee certified on this form will be notified of the revocation. Please note: This report can be submitted by either the employee or employer. To ensure the employee's privacy, when the employment is terminated with this firearms dealer or ammunition vendor, a Certificate of Eligibility Termination of Employment Notice (BOF 118) shall be submitted to DOJ. The transmittal of that form to DOJ will result in DOJ disassociating the employee with the firearms dealer. If the COE holder transfers to another firearms dealer or ammunition vendor, the COE holder information can be updated by completing a new Certificate of Eligibility Report of Employment. COE HOLDER INFORMATION: Last Name First Name Middle Name COE Number Physical Address City State Zip Code Mailing Address (if different) City State Zip Code CA Driver License or Identification Number Date of Birth Telephone Number CALIFORNIA FIREARMS DEALERSHIP/AMMUNITION VENDOR INFORMATION: Firearms Dealer Name/Ammunition Vendor Name California Firearms Dealer (CFD) Number or California Ammunition Vendor (CAV) Number Date of Employment Name of Licensee Licensee COE Number Business Address City State Zip Code EMPLOYEE DECLARATION: I certify that I currently hold the COE listed above. My employer has informed me that I am required to maintain a current COE and provide a copy to him/her. I understand that if my COE is revoked, the licensee of the aforementioned firearms dealership/ammunition vendor will be notified of the revocation. I understand that if I terminate my employment with this firearms dealership/ammunition vendor, to ensure the protection of my privacy, I will notify DOJ by submitting a Certificate of Eligibility Termination of Employment Notice (BOF 118) to DOJ within ten (10) days of termination. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Signature Date EMPLOYER DECLARATION: I certify that the following COE holder is currently an employee of the aforementioned firearms dealer/ammunition vendor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, that I am the licensee of the aforementioned firearms dealer/ammunition vendor, and possess the authority to submit this form. Signature Date If you have any questions, please contact the Bureau of Firearms at (916) 227-3751. Mail completed form to: Department of Justice Bureau of Firearms - Certificate of Eligibility Unit P.O. Box 160487 Sacramento, CA 95816-0487 FAX: (916) 227-1032